小结
定义
病史和体格检查
关键诊断因素
- 有变化的色素性皮损（ABCDE指征）
- 黑素细胞性皮损不像其周围的黑素细胞痣（“丑小鸭”现象）
- 色素性皮损自发出血或溃疡
- 全身性症状
- 甲征象：单一指（趾）甲出现持续性纵行黑甲
- 甲征象：Hutchinson 征
- 非典型的皮肤镜发现
- 固定肿大的淋巴结
- 在途转移
危险因素
- 黑色素瘤家族史
- 具有黑素瘤个人史
- 个人皮肤癌病史（包括光化损伤）
- 非典型痣的病史
- Fitzpatrick Ⅰ 型或 Ⅱ 型皮肤（白色皮肤）
- 红色或金色头发
- 高密度的雀斑
- 光暴露
- 日光浴的使用
- 浅色眼睛
- 良性黑素细胞痣数量的增加
- 巨大型先天性痣
- 免疫抑制
- 着色性干皮病
诊断性检查
首要检查
- 皮肤镜检查
- 皮肤活检
- 免疫组织化学检查
需考虑的检查
- 前哨淋巴结活检
- 胸、腹、盆腔CT扫描
- 全身 PET 扫描
- 脑影像学检查（CT 或 MRI）
- BRAF突变分析
- NRAS 突变分析
- 血清乳酸脱氢酶
新兴检查
- CDKN2A 突变分析
治疗流程
早期黑色素瘤（原位黑色素瘤、Ⅰ 期、Ⅱ 期）
可切除的晚期黑色素瘤（Ⅲ 期和 Ⅳ 期）
不可切除的晚期疾病（Ⅲ 期和 Ⅳ 期）
撰稿人
作者
Prachi Bhave, BE (Hons), MBBS, FRACP
Medical Oncologist
Peter MacCallum Cancer Centre
Victoria
Australia
利益声明
PB has received honoraria from Novartis and sponsorship from MSD and Novartis.
Yin Wu, MRCP, PhD
Wellcome Trust Clinical Research Career Development Fellow and Honorary Consultant Medical Oncologist
Peter Gorer Department of Immunobiology
King's College London
Department of Medical Oncology
Guy's and St Thomas' NHS Foundation Trust
London
UK
利益声明
YW is funded by the Wellcome Trust.
Pablo Fernandez-Peñas, MD, PhD, FACD
Associate Professor of Dermatology
The University of Sydney
Sydney
Australia
利益声明
PF-P declares that he has no competing interests with the topic Melanoma. PF-P has advisory roles with Amgen, Boehringer Ingelheim, Bristol Meyers Squibb, Leo, Novartis, Lilly, Abbvie, Janssen, Celgene (psoriasis, atopic eczema, hidradenitis), Roche, Merck Sharp & Dohme, Sun Pharmaceuticals, Novartis, and Sanofi. He has been paid to do research for Incyte Europe Sarl, and clinical trials for Arena, Akaal Pharma, Xoma, Kyowa Hakko Kirin, AbbVie, OncoSec, Lilly, CSL Behring, Boehringer Ingelheim, Pfizer, mRage, Eisai, Jiansu Hengrui, Bristol-Myers Squibb, Sun Pharma, Novartis, Roche, Galderma, Regeneron, UCB, GlaxoSmithKline, and Amgen.
鸣谢
Dr Prachi Bhave, Dr Yin Wu, and Dr Pablo Fernandez-Peñas would like to gratefully acknowledge Dr Robyn P.M. Saw, Dr Sophie E. Papa, Dr Alexander M. Menzies, Dr Philip Friedlander, Dr Hobart W. Walling, and Dr Brian L. Swick, previous contributors to this topic.
利益声明
RPMS is on the advisory board for Novartis, MSD, and Qbiotics and has previously been on the advisory board for Amgen; he has received honoraria from BMS and Novartis. SEP has received honoraria from BMS, MSD, and Novartis to attend conferences; she has participated in advisory boards for BMS, MSD, Amgen, Roche, and GSK. AMM has received honoraria from Novartis and BMS; he is on the advisory boards of MSD and Chugai. PF is a consultant for Genentech. HWW and BLS declare that they have no competing interests.
同行评议者
David Cassarino, MD, PhD
Assistant Professor
Department of Pathology and Laboratory Medicine
University of California
Los Angeles
CA
利益声明
DC declares that he has no competing interests.
James DeBloom, MD
Dermatologist/Dermatologic Surgeon
President of the South Carolina Skin Cancer Center
Greenville
SC
利益声明
JB declares that he has no competing interests.
Mai Brooks, MD, FACS
Associate Director
JCCC Women's Cancers Program Area
Jonsson Comprehensive Cancer Center at UCLA
Los Angeles
CA
利益声明
MB declares that she has no competing interests.
Karol Sikora, MA, MBBCh, PhD, FRCR, FRCP, FFPM
Medical Director
CancerPartnersUK
London
UK
利益声明
KS declares that he has no competing interests.
鉴别诊断
- 良性/发育不良的黑素细胞痣
- 脂溢性角化病
- 色素性基底细胞癌
更多 鉴别诊断指南
- 疑似癌症：识别和转诊
- 脑转移的治疗
更多 指南患者教育信息
皮肤癌（黑色素瘤）：如何定义？
皮肤癌（黑色素瘤）：如何诊断和治疗？
更多 患者教育信息
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